Location
Manchester | United Kingdom
Job description
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Contract Manager facilitates development; implementation and management of new and current cost-effective provider networks for multiple products. Under the direction of the NH Director of Contracting and Provider Engagement, he/she performs all critical functions necessary to assess, develop, maintain and/or improve provider network adequacy and performance including leading NH product expansion, recruitment and contracting efforts. The Contract Manager will lead contract language and reimbursement negotiations with a variety of provider entities across New Hampshire and will ensure contract terms and conditions comply with financial and legal requirements of Plan and its regulatory entities.
Our Investment in You:
Key Functions/Responsibilities:
- Assists our provider partners in the interpretation of data tools and analytics provided by the Plan, including Alternative Payment Arrangements (APMs) and Quality Incentive Programs (QIPs) reporting and other incentive programs developed.
- Ensures the contracting and implementation process is administered appropriately and ensures integrity of data. Ensures materials used with providers are accurate and appropriate for the given situation.
- Demonstrates knowledge of varying payment methodologies including but not limited to DRG, Capitation, APMs, Fee-for-Service, Per Diem, Per Case and Percent of Charges.
- Supports strategic network composition and design initiatives, consistent with the objectives of Well Sense.
- Leads and manages all aspects of provider implementation to ensure provider hierarchy and data are loaded appropriately in all relevant systems. This includes understanding and communicating unique arrangements and ensuring the Plan accurately administers those arrangements.
- Ensures provider compliance with contractual, regulatory and NCQA requirements and standards.
- Participates in cross-functional workgroups as requested.
- Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations;
- Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance;
- Leads negotiations of financial and other contractual terms in all lines of business;
- Ensures all contract terms and conditions comply with financial and legal requirements of Well Sense and its regulatory entities (e.g., NH DHHS, Medicare, DOI etc);
- Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers;
- Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting;
- Performs other duties as required to accomplish departmental and corporate goals & objectives.
Qualifications:
Education:
- Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required.
Experience:
- 3 years of progressive experience in a contracting and analytical capacity in a leadership role is required for individuals with a baccalaureate degree, four years experience is required for individuals without a baccalaureate degree.
Competencies, Skills, and Attributes:
- Proven analytical skill in assessing and projecting financial, utilization and quality performance on an individual provider and network basis;
- In-depth knowledge and understanding of contract finance and provider reimbursement methodologies, including risk, shared savings, pay-for-performance and other financial incentive strategies;
- In-depth knowledge and understanding of current healthcare industry issues and trends, including national and state-level payment reform landscape and strategy (e.g., accountable care and patient centered medical home);
- Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary service providers;
- Proven skill in critical thinking and strategic planning and implementation;
- Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards;
- Effective communication (verbal and written) and relationship building skills;
- Expertise in Microsoft Office programs and industry-standard financial applications as appropriate.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.
Important info on employment offer scams:
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to individuals via text, we do not ask or require downloads of any applications, or “apps”, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please follow these tips from the FTC .
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees.
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